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Molecular Technology to fight dengue
The Health Ministry plans to use 'Molecular Technology' to cut down on dengue deaths. The Ministry expects to cut down the current dengue death rate of 0.3 to 0.1 by 2016, a Health Ministry spokesman said.z_p04-siri.jpg
"The technology introduced under the direction of Health Minister Maithripala Sirisena assists health professionals to quickly and easily identify the mutations taking place in dengue viruses. At present, private hospitals in Sri Lanka do not offer Molecular Technology. The technology is available only in the state sector," the spokesman said. According to the spokesman, the technology will be used under a five year project funded by the European Union on a request by Health Minister Sirisena.
The laboratory which was ceremonially opened at the Medical Research Institute (MRI) will test 3,000 blood samples per year and one blood sample will be subjected to five different tests. The EU has provided Rs. 40 million for the project which is to be handed over to Sri Lanka after five years.
"Molecular Technology helps identify the changes of all four types of dengue viruses and it is possible to detect these changes even after the virus enters the human body. This would enable doctors to offer better medical treatment for dengue patients (depending on the latest changes of the dengue virus inside their bodies). It will help cut down on the number of dengue deaths, the spokesman said.
The data collected during testing will be made available for all dengue affected countries through an international data base at MRI. The data can be used as an early warning system when changes in the same virus are detected, he said.
"Molecular technology is capable of testing the chromosome of dengue viruses. The antigen, antibodies etc of the dengue viruses will also be tested using the technology. The treatment methodology will be changed according to the changes detected in all four types of dengue viruses because the severity of dengue fever depends on the changes of the virus," he added.
Dengue Fever Symptoms
According to data from epidemiology unit of Sri Lanka, the number of total cases recorded for year 2009 is 32713. Most affected district was Kandy. Colombo, Gampaha and Kaluthara districts which have been susceptible in the past have also recorded a high rate of infection and deaths.
- Incubation period is 2-7 days.
- All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5–41ºC) and myalgia.
- Fever is often biphasic with two peaks.
- Fever is associated with frontal or retro-orbital headache lasting 1–7 days, accompanied by generalised macular, blanching rash.
- Initial rash usually fades after 1–2 days.
- Symptoms regress for a day or two then rash reappears in maculopapular, morbilliform pattern, sparing palms and soles of feet. Fever recurs but not as high. There may be desquamation.
- DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last for weeks (hence breakbone fever).
- Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.
- Abdominal pain may occur and if severe suggests DHF pattern.The signs of dengue fever/ Dengue haemorrhagic fever are- High fever, rash, hypotension and narrow pulse pressure, poor capillary refill.
- There may be hepatomegaly and lymphadenopathy.
- A tourniquet placed on an arm may induce petechiae in early DHF cases. DHF sufferers exhibit a bleeding tendency as evidenced by petechiae, purpura, epistaxis, gum bleeding, GI haemorrhage and menorrhagia. There may be pleural effusion, ascites and pericarditis due to plasma leakage.
- Petechiae are best visualised in the axillae.
- Flushing of head and neck.
- Tender muscles on palpation.
- Periorbital oedema and proteinuria may be present.
- Maculopathy and retinal haemorrhages may also occur.
- DSS pattern cases progress through DHF until profound shock due to severe hypotension is present.
- CNS involvement e.g. encephalopathy, coma, convulsions.
- Hepatic failure: Means failure of the liver
- Encephalopathy: Means damage to the brain causing fits, loss of consciousness and confusion- Myocarditis – Inflamation of heart muscles
- Disseminated intravascular coagulation - Damage to blood vessels and blood cells causing problematic bleeding and clottingDengue can cause death
- Infection may be confirmed by isolation of virus in serum and detection of IgM and IgG antibodies for Dengue by ELISA, monoclonal antibody or haemagglutination
- Molecular diagnostic methods such as reverse-transcriptase-PCR are increasingly being used.
- Chest X-ray may show pleural effusion.
- Nutritious diet and lot of liquids, But avoid red and brown foods and drinks like coffee, chocolate, grapes etc as it may misinterpret vomiting as blood stained vomitus.
- Fever control with paracetamol, tepid sponging and fans. Aspirin should be avoided.
- Need to seek advice from a qualified medical practitioner if fever lasts for more than 2 days
- Hospital managemnt includes intravenous fluid resuscitation with close monitoring. Haemorrhage and shock will require Fresh Frozen Plasma, platelets and blood. Intensive management with inotropes of the shock syndrome may be required in severe DHF/DSS cases.
- Anti-mosquito public health measures such as reducing breeding sites ( flower pots, fish tanks,tires, coconut shells, tins, water collecting plants, gutters which can collect water) and good sewage management
- Insecticides to destroy the larvae
- Mosquito nets can be used during day time as the Aedes mosquitoes is day-biting.
- Mosquita repellents
- There is a bacteria called Bacillus thuringiensis which destroy the mosquito larvea